Проблема некомплаенса к лечению при хронических сердечно-сосудистых заболеваниях

В настоящем научном обзоре представлен анализ литературы, посвященной значимости некомплаенса пациентов к лечению при хронических сердечно-сосудистых заболеваниях (ССЗ): артериальной гипертонии (АГ), хронической сердечной недостаточности (ХСН), атеросклеротических сердечно-сосудистых заболеваниях (АССЗ). Проведен анализ частоты распространенности некомплаенса пациентов в популяционных и когортных исследованиях, взаимосвязи между некомплаенсом и исходами заболеваний. Самостоятельное значение получил системный анализ роли различных факторов, влияющих на некомплаенс пациентов к лечению при ССЗ с аспектом некомплаенса, обусловленного социально-экономическими факторами, включая стоимость лекарственных препаратов. Поиск статей, опубликованных не ранее 2000 г. и до марта 2026 г., производился в научных базах данных PubMed, MEDLINE, ScienceDirect, E-library с использованием ключевых слов: приверженность к лечению, антигипертензивная терапия, лечение ХСН, лечение статинами, дженерики кардиоваскулярных препаратов, стоимость препаратов. Было отобрано более 120 статей, из них 52 статьи для качественного анализа, а 25 статей для количественного анализа. Показано, что частота встречаемости некомплаенса при ССЗ в реальной клинической практике достаточно высока и оказывает негативное влияние на развитие неблагоприятных сердечно-сосудистых событий, ухудшает качество жизни. В обзоре нашло отражение описание специфических факторов и барьеров для оптимального соблюдения режима терапии пациентами с разными ССЗ; показана важная роль социально-экономических факторов и факторов, обусловленных стоимостью лекарственных препаратов. Изучение некомплаенса, обусловленного стоимостью лекарственных средств (ЛС), выявило 3 основных механизма: 1) задержка с получением рецепта из-за стоимости ЛС, 2) пропуск доз, 3) прием меньших доз ЛС, чем предписано, чтобы продлить срок использования (т.е. «растягивание периода»). Одним из решений данной проблемы является более широкое применение генерических препаратов, эффективность и безопасность которых доказаны в клинической практике.

1. Tolley A, Grewal K, Weiler A, Papameletiou AM, Hassan R, Basu S. Factors influencing adherence to non-communicable disease medication in India: secondary analysis of cross-sectional data from WHO – SAGE2. Front Pharmacol. 2023;14:1183818. https://doi.org/10.3389/fphar.2023.1183818.

2. GBD 2023 Disease and Injury and Risk Factor Collaborators. Burden of 375 diseases and injuries, risk-attributable burden of 88 risk factors, and healthy life expectancy in 204 countries and territories, including 660 subnational locations, 1990–2023: a systematic analysis for the Global Burden of Disease Study 2023. Lancet. 2025;406(10513):1873–1922. https://doi.org/10.1016/S0140-6736(25)01637-X.

3. Kvarnström K, Westerholm A, Airaksinen M, Liira H. Factors contributing to medication adherence in patients with a chronic condition: a scoping review of qualitative research. Pharmaceutics. 2021;13(7):1100. https://doi.org/10.3390/pharmaceutics13071100.

4. Николаев НА, Мартынов АИ, Драпкина ОМ, Ливзан МА, Моисеев СВ, Скирденко ЮП и др. Первый Российский консенсус поколичественной оценке приверженности лечению. Терапия. 2018;(5):11–32. Режим доступа: https://therapy-journal.ru/articles/Pervyi-rossiiskii-konsensus-pokolichestvennoi-ocenke-priverjennosti-lecheniu-odobren-XII-Nacionalnymkongressom-terapevtov-Moskva-22-24-noyabrya-2017.html.

5. Николаев НА, Мартынов АИ, Скирденко ЮП, Анисимов ВН, Васильева ИА, Виноградов ОИ и др. Управление лечением на основе приверженности: алгоритмы рекомендаций для пациентов. Междисциплинарные рекомендации. Медицинский вестник Северного Кавказа. 2020;15(4):461–468. https://doi.org/10.14300/mnnc.2020.15109.

6. Valgimigli M, Garcia-Garcia HM, Vrijens B, Vranckx P, McFadden EP, Costa F et al. Standardized classification and framework for reporting, interpreting, and analysing medication non-adherence in cardiovascular clinical trials: a consensus report from the Non-adherence Academic Research Consortium (NARC). Eur Heart J. 2019;40(25):2070–2085. https://doi.org/10.1093/eurheartj/ehy377.

7. Kengne AP, Brière JB, Zhu L, Li J, Bhatia MK, Atanasov P, Khan ZM. Impact of poor medication adherence on clinical outcomes and health resource utilization in patients with hypertension and/or dyslipidemia: systematic review. Expert Rev Pharmacoecon Outcomes Res. 2024;24(1):143–154. https://doi.org/10.1080/14737167.2023.2266135.

8. Baumgartner PC, Haynes RB, Hersberger KE, Arnet I. A Systematic Review of Medication Adherence Thresholds Dependent of Clinical Outcomes. Front Pharmacol. 2018;9:1290. https://doi.org/10.3389/fphar.2018.01290.

9. Ettehad D, Emdin CA, Kiran A, Anderson SG, Callender T, Emberson J et al. Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis. Lancet. 2016;387(10022):957–967. https://doi.org/10.1016/S0140-6736(15)01225-8.

10. Nazarzadeh M, Bidel Z, Canoy D, Copland E, Bennett DA, Dehghan A et al. Blood pressure-lowering treatment for prevention of major cardiovascular diseases in people with and without type 2 diabetes: an individual participant-level data meta-analysis. Lancet Diabetes Endocrinol. 2022;10(9):645–654. https://doi.org/10.1016/S2213-8587(22)00172-3.

11. Vrijens B, Antoniou S, Burnier M, de la Sierra A, Volpe M. Current Situation of Medication Adherence in Hypertension. Front Pharmacol. 2017;8:100. https://doi.org/10.3389/fphar.2017.00100.

12. Hamrahian SM, Maarouf OH, Fülöp T. A Critical Review of Medication Adherence in Hypertension: Barriers and Facilitators Clinicians Should Consider. Patient Prefer Adherence. 2022;16:2749–2757. https://doi.org/10.2147/PPA.S368784.

13. Zhou X, Zhang X, Gu N, Cai W, Feng J. Barriers and facilitators of medication adherence in hypertension patients: a meta-integration of qualitative research. J Patient Exp. 2024;11:23743735241241176. https://doi.org/10.1177/23743735241241176.

14. Abegaz TM, Shehab A, Gebreyohannes EA, Bhagavathula AS, Elnour AA. Nonadherence to antihypertensive drugs: A systematic review and metaanalysis. Medicine. 2017;96(4):e5641. https://doi.org/10.1097/MD.0000000000005641.

15. Carvalho AS, Santos P. Medication Adherence In Patients With Arterial Hypertension: The Relationship With Healthcare Systems’ Organizational Factors. Patient Prefer Adherence. 2019;13:1761–1774. https://doi.org/10.2147/PPA.S216091.

16. Lee EKP, Poon P, Yip BHK, Bo Y, Zhu MT, Yu CP et al. Global Burden, Regional Differences, Trends, and Health Consequences of Medication Nonadherence for Hypertension During 2010 to 2020: A Meta-Analysis Involving 27 Million Patients. J Am Heart Assoc. 2022;11(17):e026582. https://doi.org/10.1161/JAHA.122.026582.

17. Mahmood S, Jalal Z, Hadi MA, Khan TM, Haque MS, Shah KU. Prevalence of non-adherence to antihypertensive medication in Asia: a systematic review and meta-analysis. Int J Clin Pharm. 2021;43(3):486–501. https://doi.org/10.1007/s11096-021-01236-z.

18. Nielsen JØ, Shrestha AD, Neupane D, Kallestrup P. Non-adherence to antihypertensive medication in low- and middle-income countries: a systematic review and meta-analysis of 92443 subjects. J Hum Hypertens. 2017;31(1):14–21. https://doi.org/10.1038/jhh.2016.31.

19. Aminde LN, Agbor VN, Fongwen NT, Ngwasiri CA, Nkoke C, Nji MA et al. High burden and trend in nonadherence to blood pressure-lowering medications: meta-analysis of data from over 34 000 adults with hypertension in sub-saharan Africa. J Am Heart Assoc. 2025;14(9):e037555. https://doi.org/10.1161/JAHA.124.037555.

20. Бочкарева ЕВ, Бутина ЕК, Ким ИВ, Концевая АВ, Драпкина ОМ. Приверженность антигипертензивной терапии: систематический обзор российских проспективных исследований с 2000 по 2019 год. Рациональная фармакотерапия в кардиологии. 2020;16(5):770–779. https://doi.org/10.20996/1819-6446-2020-10-20.

21. Highton PJ, Funnell MP, Lane D, Vigneswara V, Jenkins S, Kacha G et al. Chemical adherence testing for assessing adherence to antihypertensive medications: a systematic review and meta-analysis of prevalence of nonadherence. Behav Med. 2025;51(4):265–279. https://doi.org/10.1080/08964289.2025.2503201.

22. Kulkarni S, Rao R, Goodman JDH, Connolly K, O’Shaughnessy KM. Nonadherence to antihypertensive medications amongst patients with uncontrolled hypertension: a retrospective study. Medicine. 2021;100(14):e24654. https://doi.org/10.1097/MD.0000000000024654

23. Feng Y, Zhao Y, Yang X, Li Y, Han M, Qie R et al. Adherence to antihypertensive medication and cardiovascular disease events in hypertensive patients: a dose-response meta-analysis of 2 769 700 participants in cohort study. QJM. 2022;115(5):279–286. https://doi.org/10.1093/qjmed/hcaa349.

24. Liu M, Zheng G, Cao X, Chang X, Zhang N, Liang G et al. Better medications adherence lowers cardiovascular events, stroke, and all-cause mortality risk: a dose-response meta-analysis. J Cardiovasc Dev Dis. 2021;8(11):146. https://doi.org/10.3390/jcdd8110146.

25. Чазова ИЕ, Солнцева ТД, Сивакова ОА, Агеев ФТ, Фофанова ТВ, Брагина АЕ, Трушина ОЮ. Консенсус экспертов Российского медицинского общества по артериальной гипертонии. Артериальная гипертония и приверженность к антигипертензивной терапии. Системные гипертензии. 2024;21(2):5–15. https://doi.org/10.38109/2075-082X-2024-2-5-15.

26. Savarese G, Becher PM, Lund LH, Seferovic P, Rosano GMC, Coats AJS. Global burden of heart failure: a comprehensive and updated review of epidemiology. Cardiovasc Res. 2023;118(17):3272–3287. https://doi.org/10.1093/cvr/cvac013.

27. Tromp J, Ouwerkerk W, van Veldhuisen DJ, Hillege HL, Richards AM, van der Meer P et al. A Systematic review and network meta-analysis of pharmacological treatment of heart failure with reduced ejection fraction. JACC Heart Fail. 2022;10(2):73–84. https://doi.org/10.1016/j.jchf.2021.09.004.

28. McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M et al. 2023 Focused Update of the 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: Developed by the task force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) With the special contribution of the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail. 2024;26(1):5–17. https://doi.org/10.1002/ejhf.3024.

29. Savarese G, Lindberg F, Cannata A, Adamo M, Ambrosio G, Ameri P et al. Adherence to guideline-directed medical treatments in heart failure. A scientific statement of the Heart Failure Association (HFA) of the ESC and the ESC Working Group on Cardiovascular Pharmacotherapy. Eur J Heart Fail. 2025;27(12):2716–2731. https://doi.org/10.1002/ejhf.70090.

30. Savarese G, Lindberg F, Christodorescu RM, Ferrini M, Kumler T, Toutoutzas K et al. Physician perceptions, attitudes, and strategies towards implementing guideline-directed medical therapy in heart failure with reduced ejection fraction. A survey of the Heart Failure Association of the ESC and the ESC Council for Cardiology Practice. Eur J Heart Fail. 2024;26(6):1408–1418. https://doi.org/10.1002/ejhf.3214.

31. Chang TE, Park S, Yang Q, Loustalot F, Butler J, Ritchey MD. Association between long-term adherence to class-I recommended medications and risk for potentially preventable heart failure hospitalizations among younger adults. PLoS ONE. 2019;14(9):e0222868. https://doi.org/10.1371/journal.pone.0222868.

32. Ødegaard KM, Lirhus SS, Melberg HO, Hallén J, Halvorsen S. Adherence and persistence to pharmacotherapy in patients with heart failure: a nationwide cohort study, 2014–2020. ESC Heart Fail. 2023;10(1):405–415. https://doi.org/10.1002/ehf2.14206.

33. 33 Janse RJ, Fu EL, Dahlström U, Benson L, Lindholm B, van Diepen M et al. Use of guideline-recommended medical therapy in patients with heart failure and chronic kidney disease: from physician’s prescriptions to patient’s dispensations, medication adherence and persistence. Eur J Heart Fail. 2022;24(11):2185–2195. https://doi.org/10.1002/ejhf.2620.

34. Murray-Thomas T, Bottle A, Mayet J, Myles P. Non-adherence to medications prescribed to patients with heart failure in general practice: prevalence, risk factors and association with mortality and hospitalisation. Open Heart. 2025;12(2):e003373. https://doi.org/10.1136/openhrt-2025-003373.

35. Hikaka J, Abey-Nesbit R, McIntosh B, Schluter PJ, Nishtala PS, Scrase R, Jamieson HA. Utility of big data to explore medication adherence in Māori and Non-Māori community-dwelling older adults with heart failure in Aotearoa New Zealand: a cross-sectional study. Drugs Aging. 2023;40(9):847–855. https://doi.org/10.1007/s40266-023-01044-2.

36. Bagyawantha NMYK, Dangahage IN, Mayurathan G, Suminda Pushpika WM. Evaluation of medication adherence and appropriateness among heart failure patients attending the cardiac clinic at a tertiary care hospital: A cross-sectional observational study. Pharmacy. 2025;13(4):101. https://doi.org/10.3390/pharmacy13040101.

37. El-Zein RS, Mohammed M, Nguyen DD, Hill CL Jr, Thomas L, Nassif M et al. Association of medication adherence and health status in heart failure with reduced ejection fraction: insights from the CHAMP-HF registry. Circ Cardiovasc Qual Outcomes. 2024;17(9):e010211. https://doi.org/10.1161/CIRCOUTCOMES.123.010211.

38. Pawar B, Dua P, Seth S, Maulik SK, Reeta KH. A randomized controlled trial studying the effect of medication adherence tools in patients with heart failure. Cureus. 2025;17(9):e93238. https://doi.org/10.7759/cureus.93238.

39. Rehman ZU, Siddiqui AK, Karim M, Majeed H, Hashim M. Medication nonadherence among patients with heart failure. Cureus. 2019;11(8):e5346. https://doi.org/10.7759/cureus.5346.

40. Ларина ВН, Замятин КА, Гудиев ЧГ. Уровень приверженности лечению пациентов с хронической сердечной недостаточностью: пилотное обсервационное исследование в амбулаторной практике. Российский кардиологический журнал. 2024;29(12S):6180. https://doi.org/10.15829/1560-4071-2024-6180.

41. Гусейнова ЭТ, Лукина ЮВ, Кутишенко НП, Толпыгина СН, Воронина ВП, Драпкина ОМ, Марцевич СЮ. Приверженность к медикаментозной терапии и риск сердечно-сосудистых событий у пациентов с хронической сердечной недостаточностью (по данным амбулаторного регистра). Кардиоваскулярная терапия и профилактика. 2022;21(10):3389. https://doi.org/10.15829/1728-8800-2022-3389.

42. Wu JR, Moser DK. Health-Related Quality of Life Is a Mediator of the relationship between medication adherence and cardiac event-free survival in patients with heart failure. J Card Fail. 2021;27(8):848–856. https://doi.org/10.1016/j.cardfail.2021.03.004.

43. Шляхто ЕВ, Беленков ЮН, Бойцов СА, Виллевальде СВ, Галявич АС, Глезер МГ и др. Применение рекомендованной болезнь-модифицирующей терапии у амбулаторных пациентов с хронической сердечной недостаточностью в реальной клинической практике: субанализ исследования ПРИОРИТЕТ-ХСН. Российский кардиологический журнал. 2025;30(11S):6517. https://doi.org/10.15829/1560-4071-2025-6517.

44. Malgie J, Wilde MI, Clephas PRD, Emans ME, Koudstaal S, Schaap J et al. Contemporary guideline-directed medical therapy in de novo, chronic, and worsening heart failure patients: first data from the TITRATE-HF study. Eur J Heart Fail. 2024;26(7):1549–1560. https://doi.org/10.1002/ejhf.3267.

45. Oliva F, Orso F, Colivicchi F, Cipriani MG, Di Lenarda A, Gori M et al. Medical treatments at 6 months in hospitalized and ambulatory HFrEF patients in the BRING-UP 3 Heart Failure study. ESC Heart Fail. 2026;13(2):xvag043. https://doi.org/10.1093/eschf/xvag043.

46. Gupta P, Voors AA, Patel P, Lane D, Anker SD, Cleland JGF et al. Non-adherence to heart failure medications predicts clinical outcomes: assessment in a single spot urine sample by liquid chromatography-tandem mass spectrometry (results of a prospective multicentre study). Eur J Heart Fail. 2021;23(7):1182–1190. https://doi.org/10.1002/ejhf.2160.

47. Beezer J, Al Hatrushi M, Husband A, Kurdi A, Forsyth P. Polypharmacy definition and prevalence in heart failure: a systematic review. Heart Fail Rev. 2022;27(2):465–492. https://doi.org/10.1007/s10741-021-10135-4.

48. Unlu O, Levitan EB, Reshetnyak E, Kneifati‐Hayek J, Diaz I, Archambault A et al. Polypharmacy in older adults hospitalized for heart failure. Circ Heart Fail. 2020;13(11):e006977. https://doi.org/10.1161/CIRCHEARTFAILURE.120.006977.

49. Stolfo D, Iacoviello M, Chioncel O, Anker MS, Bayes-Genis A, Braunschweig F et al. How to handle polypharmacy in heart failure. A clinical consensus statement of the Heart Failure Association of the ESC. Eur J Heart Fail. 2025;27(5):747–759. https://doi.org/10.1002/ejhf.3642.

50. Jaarsma T, Klompstra L, Strömberg A, Ben Gal T, Mårtensson J, van der Wal MHL. Exploring factors related to non-adherence to exergaming in patients with chronic heart failure. ESC Heart Fail. 2021;8(6):4644–4651. https://doi.org/10.1002/ehf2.13616.

51. Lima JG, Barros ALBL, Lopes JL. Factors associated with medication nonadherence among patients with heart failure. Rev Lat Am Enfermagem. 2024;32:e4302. https://doi.org/10.1590/1518-8345.6756.4302.

52. Rasmussen AA, Wiggers H, Jensen M, Berg SK, Rasmussen TB, Borregaard B et al. Patient-reported outcomes and medication adherence in patients with heart failure. Eur Heart J Cardiovasc Pharmacother. 2021;7(4):287–295. https://doi.org/10.1093/ehjcvp/pvaa097.

53. Nedkoff L, Briffa T, Zemedikun D, Herrington S, Wright FL. Global trends in atherosclerotic cardiovascular disease. Clin Ther. 2023;45(11):1087–1091. https://doi.org/10.1016/j.clinthera.2023.09.020.

54. Nowak MM, Niemczyk M, Florczyk M, Kurzyna M, Pączek L. Effect of statins on all-cause mortality in adults: a systematic review and meta-analysis of propensity score-matched studies. J Clin Med. 2022;11(19):5643. https://doi.org/10.3390/jcm11195643.

55. Rodriguez F, Maron DJ, Knowles JW, Virani SS, Lin S, Heidenreich PA. Association of statin adherence with mortality in patients with atherosclerotic cardiovascular disease. JAMA Cardiol. 2019;4(3):206–213. https://doi.org/10.1001/jamacardio.2018.4936.

56. Basios A, Markozannes G, Ntzani EE, Christopoulos K, Chatzi CA, Liberopoulos E et al. Prevalence and determinants of adherence to statin therapy: a systematic review and meta-analysis. Eur J Prev Cardiol. 2025:zwaf769. https://doi.org/10.1093/eurjpc/zwaf769.

57. Hope HF, Binkley GM, Fenton S, Kitas GD, Verstappen SMM, Symmons DPM. Systematic review of the predictors of statin adherence for the primary prevention of cardiovascular disease. PLoS ONE. 2019;14(1):e0201196. https://doi.org/10.1371/journal.pone.0201196.

58. Degli Esposti L, Saragoni S, Batacchi P, Benemei S, Geppetti P, Sturani A et al. Adherence to statin treatment and health outcomes in an Italian cohort of newly treated patients: results from an administrative database analysis. Clin Ther. 2012;34(1):190–199. https://doi.org/10.1016/j.clinthera.2011.12.011.

59. Rannanheimo PK, Tiittanen P, Hartikainen J, Helin-Salmivaara A, Huupponen R, Vahtera J, Korhonen MJ. Impact of statin adherence on cardiovascular morbidity and all-cause mortality in the primary prevention of cardiovascular disease: a population-based cohort study in Finland. Value Health. 2015;18(6):896–905. https://doi.org/10.1016/j.jval.2015.06.002.

60. Chen ST, Huang ST, Shau WY, Lai CL, Li JZ, Fung S et al. Long-term statin adherence in patients after hospital discharge for new onset of atherosclerotic cardiovascular disease: a population-based study of real world prescriptions in Taiwan. BMC Cardiovasc Disord. 2019;19(1):62. https://doi.org/10.1186/s12872-019-1032-4.

61. Zhao B, He X, Wu J, Yan S. Adherence to statins and its impact on clinical outcomes: a retrospective population-based study in China. BMC Cardiovasc Disord. 2020;20(1):282. https://doi.org/10.1186/s12872-020-01566-2.

62. Sigglekow F, Horsburgh S, Parkin L. Statin adherence is lower in primary than secondary prevention: a national follow-up study of new users. PLoS ONE. 2020;15(11):e0242424. https://doi.org/10.1371/journal.pone.0242424.

63. Colantonio LD, Rosenson RS, Deng L, Monda KL, Dai Y, Farkouh ME et al. Adherence to statin therapy among US adults between 2007 and 2014. J Am Heart Assoc. 2019;8(1):e010376. https://doi.org/10.1161/JAHA.118.010376.

64. Lahoz R, Seshagiri D, Electricwala B, Achouba A, Ding Y, Heo JH et al. Clinical characteristics and treatment patterns in patients with atherosclerotic cardiovascular disease with hypercholesterolemia: a retrospective analysis of a large US real-world database cohort. Curr Med Res Opin. 2024;40(1):15–25. https://doi.org/10.1080/03007995.2023.2270901.

65. Muniandy A, Lee M, Grey C, Ferrier K, Kerr AJ. Demographic differences in the initiation and maintenance of statins in the first year post ACS in New Zealand: a data linkage study (ANZACS-QI 57). N Z Med J. 2021;134(1534):31–45. Available at: https://pubmed.ncbi.nlm.nih.gov/33927436/.

66. Марцевич СЮ, Лукина ЮВ, Кутишенко НП, Дмитриева НА, Благодатских СВ, Лерман ОВ и др. Приверженность к терапии статинами пациентов высокого и очень высокого сердечно-сосудистого риска в условиях реальной клинической практики: диагностика и возможные пути решения проблемы (по данным наблюдательного исследования ПРИОРИТЕТ). Рациональная фармакотерапия в кардиологии. 2018;14(6):891–900. https://doi.org/10.20996/1819-6446-2018-14-6-891-900.

67. Schiele F, Quignot N, Khachatryan A, Gusto G, Villa G, Kahangire D et al. Clinical impact and room for improvement of intensity and adherence to lipid lowering therapy: Five years of clinical follow-up from 164,565 postmyocardial infarction patients. Int J Cardiol. 2021;332:22–28. https://doi.org/10.1016/j.ijcard.2021.03.007.

68. Mazhar F, Hjemdahl P, Clase CM, Johnell K, Jernberg T, Sjölander A, Carrero JJ. Intensity of and adherence to lipid-lowering therapy as predictors of major adverse cardiovascular outcomes in patients with coronary heart disease. J Am Heart Assoc. 2022;11(14):e025813. https://doi.org/10.1161/JAHA.122.025813.

69. Вasios A, Chatzi CA, Markozannes G, Ntzani EE, Barkas F, Tsilidis KK et al. Adherence to statins and development of atherosclerosis-related events. A systematic review and meta-analysis. J Diabetes Complications. 2025;39(8):109040. https://doi.org/10.1016/j.jdiacomp.2025.109040.

70. Harrison TN, Derose SF, Cheetham TC, Chiu V, Vansomphone SS, Green K et al. Primary nonadherence to statin therapy: patients’ perceptions. Am J Manag Care. 2013;19(4):e133–139. Available at: https://pubmed.ncbi.nlm.nih.gov/23725451/.

71. Agarwal A, Mannagudda Sandip S, Joshi A, Ashok A. The patterns of nonadherence to medication in the management of cardiovascular disease: a descriptive study. Cureus. 2024;16(9):e69810. https://doi.org/10.7759/cureus.69810.

72. Li R, Li S, Xiao N, Pan S, Yang J, Liu G, Lyu B. Cost-related non-adherence in US adults with heart failure: a repeated cross-sectional analysis of the medical expenditure panel survey, 2012 to 2021. BMJ Open. 2025;15(5):e098899. https://doi.org/10.1136/bmjopen-2025-098899.

73. Slejko JF, Ho M, Anderson HD, Nair KV, Sullivan PW, Campbell JD. Adherence to statins in primary prevention: yearly adherence changes and outcomes. J Manag Care Pharm. 2014;20(1):51–57. https://doi.org/10.18553/jmcp.2014.20.1.51.

74. Pierre-Jacques M, Gelb Safran D, Zhang F, Ross-Degnan D, Adams AS, Gurwitz J et al. Reliability of new measures of cost-related medication nonadherence. Med Care. 2008;46(4):444–448. https://doi.org/10.1097/mlr.0b013e31815dc59a.

75. Van Alsten SC, Harris JK. Cost-related nonadherence and mortality in patients with chronic disease: a multiyear investigation, National Health Interview Survey, 2000–2014. Prev Chronic Dis. 2020;17:E151. https://doi.org/10.5888/pcd17.200244.

76. Nekui F, Galbraith AA, Briesacher BA, Zhang F, Soumerai SB, Ross-Degnan D et al. Cost-related medication nonadherence and its risk factors among medicare beneficiaries. Med Care. 2021;59(1):13–21. https://doi.org/10.1097/MLR.0000000000001458.

77. Леонова МВ. Клиническая эквивалентность генериков и оригинальных препаратов, применяемых в кардиологии: что нам известно? Consilium Medicum. 2021;23(12):920–927. https://doi.org/10.26442/20751753.2021.12.201290.

78. Leclerc J, Thibault M, Midiani Gonella J, Beaudoin C, Sampalis J. Are generic drugs used in cardiology as effective and safe as their brand-name counterparts? A systematic review and meta-analysis. Drugs. 2020;80(7):697–710. https://doi.org/10.1007/s40265-020-01296-x.

79. Luo B, Yu F, Ge W, Yang X. Can generic medications be a safe and effective alternative to brand-name drugs for cardiovascular disease treatment? A systematic review and meta-analysis. Rev Cardiovasc Med. 2025;26(3):26116. https://doi.org/10.31083/RCM26116.

80. Tian Y, Reichardt B, Dunkler D, Hronsky M, Winkelmayer WC, Bucsics A et al. Comparative effectiveness of branded vs. generic versions of antihypertensive, lipid-lowering and hypoglycemic substances: a population-wide cohort study. Sci Rep. 2020;10(1):5964. https://doi.org/10.1038/s41598-020-62318-y.

81. Gagne JJ, Choudhry NK, Kesselheim AS, Polinski JM, Hutchins D, Matlin OS et al. Comparative effectiveness of generic and brand-name statins on patient outcomes: a cohort study. Ann Intern Med. 2014;161(6):400–407. https://doi.org/10.7326/M13-294.

82. Gao J, Seki T, Kawakami K. Comparison of adherence, persistence, and clinical outcome of generic and brand-name statin users: A retrospective cohort study using the Japanese claims database. J Cardiol. 2021;77(5):545–551. https://doi.org/10.1016/j.jjcc.2020.12.003.

83. Ma I, Tisdale RL, Vail D, Heidenreich PA, Sandhu AT. Utilization of generic cardiovascular drugs in Medicare’s Part D Program. Circ Cardiovasc Qual Outcomes. 2021;14(12):e007559. https://doi.org/10.1161/CIRCOUTCOMES.120.007559.